Study Objectives: Recent studies suggest that cancer patients utilize the emergency department (ED) more than the general population. Unfortunately, few studies have investigated why these patients present to the ED, and which cancers are most likely to require emergency care. Furthermore, there is a dearth of research describing which cancer types are most likely to require a repeat ED visit (bounce back). We designed a study to investigate these clinical questions. Methods: We performed a retrospective cohort study to investigate all cancer-related ED visits in the state of California using the Office of Statewide Health Planning and Development (OSHPD) database. Specifically, we queried all cancer-related ED visits for patients 18 years of age in California during the 2014 calendar year and recorded all ED admission and discharge diagnoses, cancer types, as well as admission length of stay and mortality. Bounce back visits were defined as ED return visits within 7 days of a preceding ED discharge. We also report repeat visit frequency and bounce back rate by cancer type. Cancer types were defined and categorized using primary and secondary ICD-9 codes as designated by the National Cancer Institute. All data were analyzed using SPSS data analysis software and descriptive statistics were reported. Results: In 2014 there were 70,291 patients with 98,754 cancer-related ED discharges that met study inclusion criteria. Approximately 18% of these visits resulted in a bounce back (17,788 visits), compared to 13.4% of visits in the non-cancer population. The most common ED diagnoses among bounce back visits in descending order were abdominal symptoms (pain/nausea/vomiting), septicemia, constitutional symptoms (fever/chills/fatigue/malaise), respiratory symptoms (cough/SOB), and pain. Approximately 35.6% of cancer-related bounce back visits resulted in admission to the hospital. The most common admission diagnoses in descending order, excluding the diagnosis of cancer, were septicemia, followed by pneumonia and pain. Roughly 8% of these admitted patients died in the hospital. The median length of stay for all admissions was 4 days. Notably, patients with cancer were more likely to return to the same hospital on their second visit (77.3%) versus the non-cancer population (68%). Those cancers that accounted for the most ED revisits in descending order were lung cancer, breast cancer, prostate cancer, and non-hodgkin lymphoma. This list generally mirrors the high prevalence of these cancers in the community. Those cancers with the highest percentage of bounce backs (repeat visits/index visits x 100) were small intestine (23.4%), acute myeloid leukemia (AML) (20.5%), pancreatic (18.5%), stomach (17.7%), and cutaneous T-cell lymphoma (16.7%). Conclusion: These data suggest that patients with cancer are more likely to bounce back to the ED than the general population. Furthermore, of those patients that are admitted on their second visit, there is a particularly high mortality rate. ED physicians should be aware of the high p...
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